Medicare AdvantageCoverageMedium impact
MA08.137d, Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)
Independence Blue Cross·Psychiatry, Pain Management, Anesthesiology·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage updated their medical necessity criteria and general guidelines for intravenous ketamine (Ketalar®) and intranasal esketamine (Spravato®). This affects coverage requirements and documentation standards for these specialty psychiatric treatments.
Action Required
By December 29, 2025: Review updated medical necessity criteria for ketamine and esketamine treatments. Ensure documentation meets new Medicare Advantage requirements before submitting claims. Verify prior authorization requirements and coverage guidelines have not changed.